{"id":54,"date":"2022-02-11T18:25:51","date_gmt":"2022-02-11T18:25:51","guid":{"rendered":"https:\/\/parkerlabs.qctechjunkie.com\/?page_id=54"},"modified":"2022-03-26T16:11:58","modified_gmt":"2022-03-26T16:11:58","slug":"request-a-sample","status":"publish","type":"page","link":"https:\/\/www.parkerlabs.com\/parkerlabs-products\/request-a-sample\/","title":{"rendered":"Request a Sample"},"content":{"rendered":"\n<div class=\"wp-block-columns has-grey-background-color has-background is-layout-flex wp-container-2 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:75vw\">\n            <script type=\"text\/javascript\">\n            jQuery(document).ready(function($) {\n                $.fn.checkboxLimit = function(n) {\n\n                    var checkboxes = this;\n\n                    this.toggleDisable = function() {\n\n                        \/\/ if we have reached or exceeded the limit, disable all other checkboxes\n                        if(this.filter(':checked').length >= n) {\n                            var unchecked = this.not(':checked');\n                            unchecked.prop('disabled', true);\n                        }\n                        \/\/ if we are below the limit, make sure all checkboxes are available\n                        else {\n                            this.prop('disabled', false);\n                        }\n\n                    }\n\n                    \/\/ when form is rendered, toggle disable\n                    checkboxes.bind('gform_post_render', checkboxes.toggleDisable());\n\n                    \/\/ when checkbox is clicked, toggle disable\n                    checkboxes.click(function(event) {\n\n                        checkboxes.toggleDisable();\n\n                        \/\/ if we are equal to or below the limit, the field should be checked\n                        return checkboxes.filter(':checked').length <= n;\n                    });\n\n                }\n            });\n            <\/script>\n\n            <script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_opera gform_wrapper gravity-theme' id='gform_wrapper_2' ><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/wp-json\/wp\/v2\/pages\/54' novalidate> \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n                        <div class='gform_body gform-body'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_2_11\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_11\"><h3 class=\"gsection_title\">Please Choose Samples<\/h3><\/div><fieldset id=\"field_2_17\"  class=\"gfield gfield--width-full plabs-sample-selection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_17\"><legend class='gfield_label gfield_label_before_complex'  >Samples<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_2_17'><div class='gchoice gchoice_2_17_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.1' type='checkbox'  value='Aquasonic 100'  id='choice_2_17_1'   aria-describedby=\"gfield_description_2_17\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_1' id='label_2_17_1'>Aquasonic 100<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.2' type='checkbox'  value='Aquasonic Clear'  id='choice_2_17_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_2' id='label_2_17_2'>Aquasonic Clear<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.3' type='checkbox'  value='Aquaflex'  id='choice_2_17_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_3' id='label_2_17_3'>Aquaflex<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.4' type='checkbox'  value='Aquagel'  id='choice_2_17_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_4' id='label_2_17_4'>Aquagel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.5' type='checkbox'  value='Eclipse'  id='choice_2_17_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_5' id='label_2_17_5'>Eclipse<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.6' type='checkbox'  value='Eclipse 3D'  id='choice_2_17_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_6' id='label_2_17_6'>Eclipse 3D<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.7' type='checkbox'  value='Polysonic'  id='choice_2_17_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_7' id='label_2_17_7'>Polysonic<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.8' type='checkbox'  value='Polysonic with Aloe Vera'  id='choice_2_17_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_8' id='label_2_17_8'>Polysonic with Aloe Vera<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.9' type='checkbox'  value='Protex Disinfectant Spray'  id='choice_2_17_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_9' id='label_2_17_9'>Protex Disinfectant Spray<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.11' type='checkbox'  value='Scan'  id='choice_2_17_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_11' id='label_2_17_11'>Scan<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.12' type='checkbox'  value='Signacreme'  id='choice_2_17_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_12' id='label_2_17_12'>Signacreme<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.13' type='checkbox'  value='Signagel'  id='choice_2_17_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_13' id='label_2_17_13'>Signagel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.14' type='checkbox'  value='Signaspray'  id='choice_2_17_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_14' id='label_2_17_14'>Signaspray<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.15' type='checkbox'  value='Spectra 360'  id='choice_2_17_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_15' id='label_2_17_15'>Spectra 360<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.16' type='checkbox'  value='Sterile Aquasonic'  id='choice_2_17_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_16' id='label_2_17_16'>Sterile Aquasonic<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.17' type='checkbox'  value='UltraDrape'  id='choice_2_17_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_17' id='label_2_17_17'>UltraDrape<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_17_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.18' type='checkbox'  value='UltraDrape II'  id='choice_2_17_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_17_18' id='label_2_17_18'>UltraDrape II<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_2_17'>Limit 4<\/div><\/fieldset><div id=\"field_2_4\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_4\"><h3 class=\"gsection_title\">Contact Information<\/h3><\/div><fieldset id=\"field_2_1\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_1\"><legend class='gfield_label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_2_1'>\n                            \n                            <span id='input_2_1_3_container' class='name_first' >\n                                                    <input type='text' name='input_1.3' id='input_2_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_1_3' >First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_1_6_container' class='name_last' >\n                                                    <input type='text' name='input_1.6' id='input_2_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_1_6' >Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_2_3\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_3\"><legend class='gfield_label gfield_label_before_complex'  >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email' id='input_2_3_container'>\n                                <span id='input_2_3_1_container' class='ginput_left'>\n                                    <input class='' type='email' name='input_3' id='input_2_3' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_2_3' >Enter Email<\/label>\n                                <\/span>\n                                <span id='input_2_3_2_container' class='ginput_right'>\n                                    <input class='' type='email' name='input_3_2' id='input_2_3_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_2_3_2' >Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_2_5\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_5\"><label class='gfield_label' for='input_2_5' >Job Title<\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_2_5' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_2_6\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_6\"><label class='gfield_label' for='input_2_6' >Company Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_2_6' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_2_7\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_7\"><legend class='gfield_label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address' id='input_2_7' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_2_7_1_container' >\n                                        <input type='text' name='input_7.1' id='input_2_7_1' value=''    aria-required='true'    \/>\n                                        <label for='input_2_7_1' id='input_2_7_1_label' >Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2' id='input_2_7_2_container' >\n                                        <input type='text' name='input_7.2' id='input_2_7_2' value=''     aria-required='false'   \/>\n                                        <label for='input_2_7_2' id='input_2_7_2_label' >Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city' id='input_2_7_3_container' >\n                                    <input type='text' name='input_7.3' id='input_2_7_3' value=''    aria-required='true'    \/>\n                                    <label for='input_2_7_3' id='input_2_7_3_label' >City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state' id='input_2_7_4_container' >\n                                        <input type='text' name='input_7.4' id='input_2_7_4' value=''      aria-required='true'    \/>\n                                        <label for='input_2_7_4' id='input_2_7_4_label' >State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip' id='input_2_7_5_container' >\n                                    <input type='text' name='input_7.5' id='input_2_7_5' value=''    aria-required='true'    \/>\n                                    <label for='input_2_7_5' id='input_2_7_5_label' >ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country' id='input_2_7_6_container' >\n                                        <select name='input_7.6' id='input_2_7_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini (Swaziland)' >Eswatini (Swaziland)<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard and McDonald Islands' >Heard and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macau' >Macau<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Korea' >North Korea<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena' >Saint Helena<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia' >South Georgia<\/option><option value='South Korea' >South Korea<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen Islands' >Svalbard and Jan Mayen Islands<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' selected='selected'>United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_2_7_6' id='input_2_7_6_label' >Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_2_8\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_8\"><label class='gfield_label' for='input_2_8' >Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_2_8' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_9\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_9\"><label class='gfield_label' for='input_2_9' >Focus<\/label><div class='ginput_container ginput_container_select'><select name='input_9' id='input_2_9' class='large gfield_select'     aria-invalid=\"false\" ><option value='' >Please Select<\/option><option value='Both' >Both Diagnostic and Therapeutic<\/option><option value='Diag' >Diagnostic<\/option><option value='NA' >Not Applicable<\/option><option value='NM' >Non-Medical<\/option><option value='Thera' >Therapeutic<\/option><option value='UN' >Unknown<\/option><option value='VET' >Veterinary<\/option><\/select><\/div><\/div><div id=\"field_2_10\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_10\"><label class='gfield_label' for='input_2_10' >Specialty<\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_2_10' class='large gfield_select'     aria-invalid=\"false\" ><option value='' >Please Select<\/option><option value='ATH' >Athletic Trainer<\/option><option value='CHR' >Chiropractor<\/option><option value='COR' >Colon\/Rectal Physician<\/option><option value='COS' >Cosmetician<\/option><option value='FP' >Family Practice<\/option><option value='GP' >General Practice<\/option><option value='GST' >Gastroenterologist<\/option><option value='INT' >Internal Medicine<\/option><option value='MW' >Midwife<\/option><option value='OB' >Obstetrics<\/option><option value='OB\/GYN' >Obstetrics\/Gynecology<\/option><option value='ONC' >Oncology<\/option><option value='OTH' >Other<\/option><option value='PED' >Pediatrics<\/option><option value='PHT' >Physical Therapy<\/option><option value='PHY' >Physical Medicine<\/option><option value='POD' >Podiatry<\/option><option value='PRO' >Proctology<\/option><option value='RAD' >Radiology<\/option><option value='SPM' >Sports Medicine<\/option><option value='ULT' >Ultrasound Physician<\/option><option value='UN' >Unknown<\/option><option value='URO' >Urologist<\/option><option value='WET' >Veterinary Medicine<\/option><\/select><\/div><\/div><div id=\"field_2_13\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_13\"><label class='gfield_label' for='input_2_13' >Comments\/Questions<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_13' id='input_2_13' class='textarea large'  aria-describedby=\"gfield_description_2_13\" maxlength='1000'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_2_13'>Maximum Characters: 1000<\/div><\/div><fieldset id=\"field_2_14\"  class=\"gfield plabs-consent field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_14\"><legend class='gfield_label gfield_label_before_complex'  >Consent<\/legend><div class='ginput_container ginput_container_consent'><input name='input_14.1' id='input_2_14_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_2_14 gfield_description_2_14\"  aria-invalid=\"false\"   \/> <label class=\"gfield_consent_label\" for='input_2_14_1' >Opt-In<\/label><input type='hidden' name='input_14.2' value='Opt-In' class='gform_hidden' \/><input type='hidden' name='input_14.3' value='6' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_14'>By submitting your email address, telephone number, and physical address, you are indicating your consent to receiving marketing communications from Parker Laboratories, Inc.<\/div><\/fieldset><div id=\"field_2_15\"  class=\"gfield gfield_html gfield_html_formatted field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_15\">We respect your privacy and do not share or sell your information with anyone. 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